State funding for suicide prevention and mental health crises services has increased over the past five years but varies across the United States, according to a new study led by researchers at NYU School of Global Public Health.
The findings, published in the journal JAMA Network Open, also show that small fees tacked onto monthly phone bills are an effective and sustainable approach to finance 988, the national suicide and crisis lifeline launched in 2022.
"Mental health advocates have recommended the use of telecom fees to fund 988, but until now, we haven't fully understood if they are making a difference. The answer is empirically 'yes'—states that have these telecom fees put more money toward funding suicide prevention," said Jonathan Purtle , professor of public health policy and management at NYU School of Global Public Health, who led the research.
Suicide is a leading cause of death in the US. The 988 Suicide and Crisis Lifeline is designed to connect people across the country experiencing mental health crises with help using a simple three-digit phone number to call, text, or chat.
When people contact 988, they are connected to local call centers, which are largely funded by individual states. The majority of states finance these crisis services through their general budget appropriations, while 12 states have created telecom fees. These small, flat fees—for instance, 30 cents per cell phone line per month—are also how 911 is paid for in many states.
"Most states are funding 988 through non-fee mechanisms. We wanted to look at state budgets in the past six years to get a sense of how these services are funded, given the growing policymaker and public concern about suicide and mental health crises," said Purtle.
The researchers examined annual state budgets—which may include both state and federal funds—for all 50 states and Washington, DC, from 2021 through 2026. They looked at what states allocated for suicide prevention and mental health crisis services in their budgets and whether this varied based on a variety of state-level factors.
They found that spending on suicide prevention and crisis services increased over time, from an average of $1.05 per resident in 2021 to $6.55 in 2025. Similarly, the researchers saw an increase in the proportion of states' annual budgets devoted to suicide prevention from 0.022% to 0.079% of the overall budget.
Spending was highest in states in the West (an average of $7.19 per person per year), followed by the Northeast ($3.44), the South ($2.12), and the Midwest ($2.07). In addition, spending was twice as large in states that had enacted telecom fees.
"The finding that states with telecom fees allocated significantly more funding for suicide prevention suggests that such fees are a promising strategy to enhance crisis service infrastructure," said Purtle.
The researchers also looked at whether states with higher suicides rates are spending more money on suicide prevention and found that this wasn't necessarily the case.
Although funding for suicide prevention increased over time, the researchers note that the magnitude of spending is still relatively small. For veterans—whose suicide risk notably higher, more than double that of nonveterans—the Department of Veterans Affairs spends $177 per veteran per year on suicide prevention.
The researchers caution that it's difficult to draw conclusions about individual states, given that each state structures its budget differently and not all have specific line items or fees for suicide prevention efforts. For instance, if a state budgeted for mental health programs, but didn't specify how much would support suicide prevention and crisis services, the state was not classified as funding suicide prevention or crisis servies that year.
"As a result, our findings are likely an underestimate of what states spend on suicide prevention," said Purtle.
Research is beginning to show a decline in suicide rates since the launch of 988, but has not yet explored whether it varies among states. Purtle's ongoing research will look at whether state-level funding for 988 actually reduces suicide deaths—and in particular, whether telecomm fees move the needle as a policy solution.
In addition to Purtle, study authors include Michal Weiss and Jennifer Pomeranz of NYU School of Global Public Health, Ryan McBain and Jonathan Cantor of RAND, and Sachini Bandara, Fernanda Montoya, and Elizabeth Stuart of Johns Hopkins Bloomberg School of Public Health. The research was funded by the National Institute of Mental Health (R01 MH131649). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
